Student Anxiety and Depression in Our Schools

Cindilee Hayden

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SELU Research Review Journal, 1(2), 29–48.

SELU
Saskatchewan Education Leadership Unit
selu.usask.ca
 SELU
Research Review
Journal

volume 1
issue 2
2016

selu.usask.ca

Editorial
Vicki Squires 3

Engaging the Middle Years’ Male Students

Paul Strueby 5

Examining Mental Health in Schools and the Role

it Plays in Supporting Students
Mark Engelhardt 17

Student Anxiety and Depression in Our Schools

Cindilee Hayden 29

Make Space for Indigeneity: Decolonizing Education

Tiffany Smith 49

First Nations Instructional Leadership for the

Twenty-first Century
Rosemary Morin 61

Unpacking the Impact of School Culture: A Principal’s

Role in Creating and Sustaining the Culture of a School
Jamie Prokopchuk 73

How to Create a Resistance-Free Environment for

Successful Distributed Leadership in Education
Ashraf Salem 83

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© Saskatchewan Educational Leadership Unit Research Review Journal, 2016

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The SELU Research Review Journal (SRRJ) is a forum for graduate student research reviews capturing
the state of current research in Educational Administration. Topics related to leadership, policy, and the
administration of K-12 education, post-secondary education, and other educational institutions are the
focus of this journal. The work published in the journal reflects graduate students’ work throughout
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College of Education Department of

Educational Administration

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ii
 Student Anxiety and Depression in Our Schools

Cindilee Hayden

Abstract
According to numerous scholarly articles, books, and professional research, mental health is-
sues in the schools have become more prevalent and much is being done to assist these children
at becoming more successful in the classroom. Two emotional behavioural disorders that
plague children are anxiety and depression. Engaging in diagnosis and assessment, examin-
ing causal factors, and planning effective intervention need to be closely investigated if chil-
dren are to become successful as youth and into adulthood. Early diagnosis and intervention
is key for these children to recover. School connectedness, positive peer interactions, stable
home environments, effective instruction in the classroom, and compassionate leadership are
all necessary when interacting and teaching these children positive behaviours. Implement-
ing a wrap-around approach to assist children with emotional behavioural disorders is key
and has proven effective in many school settings.
Keywords: anxiety disorder, depressive disorder, causal factors, prevention, assessment,
treatment, intervention

Mental health issues in schools lead to negative outcomes and results because of a variety of reasons.
Kauffman (2013) stated that negative outcomes can be, “[p]overty, abuse and neglect, harsh and incon-
sistent discipline, and a variety of factors related to family, neighbourhood, school and societal condi-
tions” (p. 55). The impacts mental illness can have on all factors of a child’s life are well documented
and research supports that early intervention is best (Scharfstein, Alfano, Beidel, & Wong 2011; Ellis &
Hudson, 2010; Tomb & Hunter, 2004). Causal factors of emotional behavioural disorders in children
range from ineffective parenting practices (Barry, Frick, & Grafeman, 2008) to fears and anxieties of
gifted learners (Lamont, 2012) to social contexts such as: infant temperament, socio-economic factors,
characteristics of the neighbourhood, capacity of the extended family, and stressors that impact the
family (Kauffman, 2013). There is a need for school based mental health programs and presently there
are many that are being delivered in the schools. With provincial funding being an issue many of these
programs are not as intensive as they should be and delivery of them is not as frequent either. Effective
interventions need to be implemented early and contact with students needs to be frequent (Kauffman,
2013). Cognitive behavioural therapy (CBT) can be done at the school level and parental involvement
increases the effectiveness of the intervention being used. There are a variety of intervention programs
that involve the parents and brief cognitive behavioural therapy (BCBT) is effective because of the early
intervention and parental involvement (Beidas, Mychailyszyn, Podell, & Kendall, 2013). In order to
implement these programs at the school level, effective leadership needs to be in place to offer supports
as needed. Timetabling can impact program delivery and facilitate effective teaching strategies that pro-
vide students with emotional behavioural disorders (EBD) opportunities for success. Collaboration of
family, school, community, and mental health systems contributes to positive educational outcomes and
proves to be more effective than a fragmented approach (Weist, Rubin, Moore, Adelsheim, & Wrobel,
2007). Inclusive leadership practices can be instrumental in this process.
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 SRRJ 1(2)

Further bridging of research needs to be done in the area of mental health in schools and further
analysis into the emerging fields of school mental health (SMH), prevention, and implementation of
intervention programs (Weist, Steigler, Stephan, Cox, & Vaughn, 2010). Future research into programs
like the Coping Cat program that involves the parents, needs to be done as well as examining a larger
sample size and facilitating booster treatment sessions (Keehn, Lincoln, Brown, & Chavira, 2013). It is
necessary that further research into treatment and assessment be done in order to design individualised
treatment for children with EBD (Frick, 2012). More efficient use of school time for assessment and
intervention and staff training could lead to an increase in the amount of children who will be able to
receive intervention programs (O’Callaghan & Cunningham, 2015). Early intervention is necessary for
prevention of EBD and co-morbidity issues also need to be examined if treatment is going to be success-
ful and accurate (Kaufmann & Landrum, 2013).

Purpose

The purpose of this study is to examine two mental health issues that are prevalent in the schools:
anxiety and depression. Often when one mental health disorder is present another one is as well. This
cooccurrence of disorders is referred to as comorbidity. If leaders and educators are aware of the chal-
lenges these students face, then intervention and recovery can take place.

Research Questions

The goal of this research is to examine school based mental health (SBMH) programs and what
makes them successful. There are many programs in place and all are successful to some degree. The
research questions I will examine are:
1. What are the most prevalent mental health disordersin school children?
2. What are the underlying correlational or causal factors of these disorders?
3. What can be done to prevent these mental health disorders?
4. What are appropriate and effective intervention strategies that can be implemented in the class-
room and home of struggling students?
5. Given these findings, what are the key recommendations or strategies that we can implement to
assist these students?

Significance of the Study

This research is important because of the growing need for intervention in schools. In Saskatoon
Public School Division (SPSD) there are many programs in place that have been established to meet the
needs of students with mental health issues (Saskatoon Public Schools, n.d.). These programs are ever
evolving as new research and programming is discovered and the team of educational psychologists pro-
vide leadership for the entire school division in this area. Programs have been created to meet the needs
of students from 3-22 years of age. Research will further benefit the development and evolution of these
programs. Recently I have begun teaching in the Resource Room and I see the need for these programs
to continue to be developed and modified to meet individual students’ needs. Greene (2009) stated, “[c]
hallenging behaviour occurs when the demands and expectations being placed upon a child outstrip
the skills he has to respond adaptively” (p. 27). It is up to us as educators to know when we are placing
too high of expectations on children and to know what to do to modify their environment or learning
in order to facilitate success. Allowing them to voice their frustrations is a good starting point and
that is what Green (2009) proposed in his book, Lost at School. There is a need for developing effective
school-based mental health programs, including developing classroom management plans long before
the students enter the classroom (Simonsen, Fairbanks, Briesch, Myers, & Sugai, 2008). This research
30
 Hayden (2016)

will examine: what effective collaboration looks like, what programs are in place that are successful,
and what effective leadership strategies need to be implemented to make sure mental health is a priority.
This research will provide more strategies and programs that can be implemented in the schools to
support school-based mental health programming. Effective ways of supporting our students without
excluding them will also be examined. Researching effective programming and the impact it has on stu-
dent achievement might facilitate implementation of future programs implemented in school divisions.
Identifying needs in schools might also influence the ministry’s decision when deciding on priorities for
programs and funding allocation. School boards can also use this information when making decisions
regarding how student needs will be met. This research also will outline effective, collaborative leader-
ship practices that continue to support mental health in schools and will examine how these practices
impact student achievement, well- being, and success.

Methodology

This research included a synthesis of studies that used both quantitative and qualitative measure-
ments. ERIC (Ovid) Education Resources Information Center, Google Scholar, the Education Library,
the Murray Library, and the Stewart Resources Center were used to conduct the literature searches. I
also conducted online searches at the University of Saskatchewan Library to gather a variety of resources
that were scholarly, peer-reviewed articles as well as books that fit with the two areas of mental health
that I am researching
When researching I looked for articles in the various themes: anxiety in school aged children; depres-
sion in school aged children; causal factors of both, diagnosis and assessment; intervention and treat-
ment; and effective leadership and teaching practices when dealing with mental health in the schools.
There is a significant amount of research in the field and I had to further refine my searches to access
resources that were going to be the best fit for what I was studying.

Anxiety in School Age Children

Hayden (2015) stated, “[a]ccording to numerous scholarly journal articles, books and professional
research, anxiety in school age children is the number one mental health disorder in schools” (p. 2). In
fact, 90% of teachers report mental health issues are their biggest concern in todays classroom (Cana-
dian Teachers’ Federation, 2012). There are a significant number of problems that have been detected as
a result of untreated anxiety, ranging from decreased educational and vocational achievement, to suicide
(Dadds & Roth, 2007). It is interesting to note that 12-20 % of children are affected by anxiety and yet
they rarely receive appropriate or effective intervention (L. Miller, personal communication, March 29,
2015). There are several anxiety disorders and they can co-exist. According to Kearny, Pawlukewicz,
and Guardino (2014) the disorders can be: “separation anxiety disorder, generalized anxiety disorder,
social phobia, specific phobia, panic disorder, post-traumatic stress disorder, obsessive-compulsive dis-
order, and selective mutism” (p. 59). Aschenbrand and Kendall (2012) stated, “ children with anxiety
disorder also met criteria for attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant
disorder” (p. 233).

Causal Factors and Prevention

Anxiety and low self-concept can result from a lack of social competence and withdrawal that results
in further isolation (Kauffman & Landrum, 2013). Biological and genetic factors also play a role (Kauff-
man, 1997).
Parents. Parental overrestrictiveness and parents who are socially obtuse or awkward are likely to
have children whose social skills are not developed because they model social awkwardness and may
not have the coping skills necessary to deal with their emotions (Kauffman et al., 2013; Kearny et al.,
2014). Parents who suffer from anxiety tend to disengage from their children and their child is left to

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deal with their emotions on their own (Kearny et al., 2014). Those parents who intervene too soon can
also contribute to anxiety in their children (Aschenbrand & Kendall, 2012). Parents of children with
anxiety disorder (PAD) and children who did not have anxiety-disorder (PNAD) were tested by listen-
ing to a taped interaction between a mother and a child. The parents were asked to press a button when
they thought the mother should do what the child was asking. It was noted that PNAD took longer to
respond and give in to child requests when they thought the child was anxious (Aschenbrand & Kend-
all, 2012). If parents are able to manage their own distress they will be better equipped to refrain from
interference and avoidance (Aschenbrand & Kendall, 2012). Further research needs to be done when
assessing intervention of parents with anxious child behaviour.
Peer and teacher relationships. Students who perceived themselves as less competent in the school
setting, in either academics or sports, tended to exhibit anxious behaviour when transitioning from one
school to the next and more specifically from elementary to junior or middle school. According to Loke
and Lowe (2014), “students mentioned concerns about older students, bullies, and the development of
friendships” (p. 213). As students try to make new friends in high school, the unfamiliarity of finding
new peers and exposure to bullying can increase anxiety (Loke & Lowe, 2014). Students also experi-
ence anxiety when transitioning from elementary to middle and junior high school. They worry about
teacher expectations and teacher-student relationships and have identified developing relationships with
teachers as one of the most difficult aspects of high school (Loke & Lowe, 2014). Topping (2011) found
that, “students in transition had an intense focus on interpersonal relationships, such as social networks
in and out of school” (p. 218). Leyfer, Gallo, Cooper-Vince, and Pincus (2013) alluded that, by identify-
ing risk factors such as lack of perceived control, treatment measures could be determined.
Gifted learners. According to Lamont (2012), “gifted learners report more insomnia and fear of
the unknown than regular education students” (p. 271). Students who are perfectionists can also suffer
from depression and anxiety. Gifted learners may also be affected by their asynchronous development,
which refers to uneven levels of cognitive and social maturity. They may be able to understand difficult
concepts such as death but are not ready to handle it emotionally (Lamont, 2012). Research shows gifted
students exhibit fear more than their non-gifted counterparts (Derevensky & Coleman, 1989). There are
many reasons why gifted learners are more anxious than their non-gifted peers.
Prevention. Since anxiety and depression can be comorbid, looking at prevention programs that
target both can be more effective than looking at them separately. Dadds and Roth (2008) contended
that, “waiting until children are in late childhood or adolescence may not be the most effective way
to prevent internalizing disorders” (p. 321). These disorders are elevated levels of anxiety and depres-
sion. Early intervention is key to prevention. Changes in parenting style can also magnify or diminish
internalizing problems in children (Dadds & Roth, 2008). Intervening when children are young will
steer them to a more resilient path of development (Dadds & Roth, 2008). A program titled REACH for
RESILIENCE was run with parents for six sessions over three months. These participants were parents
of youth who had been recently diagnosed with anxiety. The sessions were organized in the following
manner: empathic responding, encouragement, behaviour management, building self-esteem, cognitive
behavioural sessions for self-talk, problem solving, and integration and review (Dadds & Roth, 2008).
Parents found the program useful and enjoyed the positive approach of the sessions (Dadds & Roth,
2008). These results support the necessity for early intervention for youth with anxiety issues.
Tomb and Hunter (2004) stated, “[p]reventive intervention can reduce the number or significance
of risk factors that may contribute to the onset of a disorder” (p. 89). Teaching coping skills to children
as early as possible will help them deal with stress and lower anxiety (Tomb & Hunter, 2004). These
preventive interventions should target various environments, such as home and school (Tomb & Hunter,
2004). Tomb and Hunter described several promising intervention models. For example, the three
tiered model of preventive intervention was first outlined by a 1994 Institute of Medicine report (Tomb
& Hunter, 2004). Ready…Set…R.E.L.A.X. (Allen, Klein, & Rodger, 1996) is a mental health program
that can be used with an entire school and smalls groups of children. The program integrates music,
self-talk, and relaxation exercises to promote positive self-esteem and promote learning. The School

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Transitional Environment Project (STEP) (Felner, Favazza, Brand, Gu, & Noonan, as cited in Tomb &
Hunter, 2004) creates an easier transitional environment to a new school by restructuring the role of the
homeroom teacher to be one that is more supportive with a stable group of peers for homeroom classes.
Prior to school start up teachers receive training on adolescent emotional and developmental issues that
might arise. Tomb and Hunter (2004) outlined:
[t]he FRIENDS for Children program (Barrett, Lowry-Webster, & Turner, as cited in Tomb &
Hunter, 2004) is a 12 session cognitive-behavioural intervention based on Kendall’s (1994) Coping
Cat program and targets children who are at risk of anxiety disorders as well as those who may not
be at risk. (p. 95)
There are ten weekly sessions for students and four evening sessions for parents. This program can be
led in classrooms and improvement from pre to post self-assessment on anxiety was noted. Tomb and
Hunter maintained, “[b]y adopting a prevention model, schools can increase their ability to identify
and treat students and minimize or prevent the development of anxiety disorders” (p. 98). Tomb and
Hunter’s findings support the research of Shortt, Barrett and Fox (2001), who similarly found promising
results with the use of this program.

Assessment, Treatment and Intervention

The Community Initiatives Fund (CIF) invested $3,902,490 through 213 grants in the 2011-2012
year to support community-based initiatives that help improve the health and well- being of vulner-
able children, youth, and families in Saskatchewan (Saskatchewan Community Grant Programs, 2012).
Health Canada also has a wealth of resources and programs to access to assist communities in developing
community-based approaches to better health (Canada, n.d. Health Canada).
Children who do not exhibit appropriate behaviours can begin to improve their self- image when they
are taught social interaction skills and and can interact with children who have appropriate behaviours.
Kauffman and Landrum (2013) explained that:
specific intervention strategies based on social learning principles include these: reinforcing social
interaction (perhaps with praise, points, or tokens), providing peer models of social interaction, pro-
viding training (models, instruction, rehearsal, and feedback) in specific social skills, and enlisting
peer confederates to initiate social interactions and reinforce appropriate social responses. (p. 288)
School. Ellis and Hudson (2010) maintained, “ [r]esearch suggests that there are strong links be-
tween worry and anxiety” (p. 152). Children worry about a range of situations. They can worry about:
being separated from loved ones, academic performance, social situations, teachers, and bullying (L.
Miller, personal communication, March 29, 2015). Worrying about school situations can also impact
attendance. Knowing that this behaviour can happen gives educators insight into how they can inter-
vene and assist children struggling with anxiety. Students experiencing social anxiety disorder have a
fear of embarrassing themselves and being negatively evaluated by others (L. Miller, personal communi-
cation, March 29, 2015). They have a tendency to try and interpret what others are thinking and avoid
social situations. Students can also fear: tests, writing on the board, reading aloud, eating in public,
joining a group, and initiating a conversation (L. Miller, personal communication, March 29, 2015). If
educators and administrators are aware of these fears then intervention and treatment can take place.
Assessment. McLoone, Hudson, and Rapee (2006) reported, “[c]hildren who are experiencing high
levels of anxiety can be identified in the school setting in several ways” (p. 225). Self-report question-
naires can be used but not in isolation. The Spence Children’s Anxiety Scale (SCAS) (Spence, 1998) is
one tool that can be used to measure anxiety (McLoone et al., 2006). Clinical interviews reveal what
types of anxiety are present, the severity of these symptoms, and the resulting impairments (Mcloone et
al., 2006). The most common interview used is the Anxiety Disorders Interview Schedule for Children
(Silverman & Albano, 1996). This interview has a component for both the parent and the child. It
is important to remember to keep parents informed and involved throughout this assessment process
(McLoone et al., 2006).

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Treatment and intervention. There are several programs that are presently available for schools.
Three programs that have been evaluated in the school setting are: The Cool Kids Program (Misfud &
Rapee, 2005), The FRIENDS Program (Lowry-Webster, Barrett & Dadds, 2001), and The Skills for
Social and Academic Success (SSAS) Program (Fisher, Masia-Warner, & Klein, 2004). Central compo-
nents to all of the Cognitive Behaviour Therapy (CBT) are cognitive restructuring and graded exposure
(McLoone et al., 2006). Graded exposure is necessary to help children address their fears and realise
that certain situations are not as intimidating as they thought they might be. This exposure also teaches
children that they have skills to cope with situations (Mcloone et al., 2006). Rewards can be used to
keep the child motivated as they develop courageous behaviour. The FRIENDS program is universal
and can be implemented as part of the school curricula to an entire classroom (Barrett, Lowry-Webster,
& Holmes, 1998). This approach removes the risk of stigmatization of children and incorporates peer
support and modelling (McLoone et al., 2006). It is run in ten hourly sessions, once weekly and is
followed up with booster sessions that are held one month and three months after completion of the
program. FRIENDS focuses on peer support and learning, making more friends, and increasing social
networks. This program is especially helpful for children with Social Anxiety Disorder (SAD) because
these children interact less with peers, initiate fewer interactions, and receive fewer positive comments
from their peers (McLoone et al., 2006; Scharfstein et al., 2011).
The Cool Kids Program is administered to small groups of children based on screening (McLoone et
al., 2006). A school counsellor leads the small group through ten hourly sessions held weekly. Sessions
can be held during the day or after school and there are also two parent-therapist meetings to encour-
age at home practice and facilitate ongoing communication (McLoone et al., 2006). The program has
been run with children ages seven to sixteen and produced reduced levels of anxiety in children upon
completion.
The SSAS program is designed to treat social phobia (Fisher et al., 2004). Students are selected based
on self-reports and teacher recommendations and is led by a clinical psychologist. It consists of twelve,
forty-five minute sessions with two individual and booster sessions. Two sessions are held for parents,
two for staff, and four weekend events that involve a peer-assistant, who is a classmate that has agreed to
befriend a child in the program (McLoone et al., 2006). The real life challenges that are presented in the
classroom are dealt with at the school level making this an effective intervention that allows the teacher
to monitor progress (McLoone et al., 2006).
Over time, anxiety symptoms can rob children of normative development and achievements. Parents
vacillate between trying to help their children and becoming frustrated when their child refuses to go
to school (Miller, Short, Garland, & Clark, 2010). Classroom intervention is effective because teachers
see their students more frequently and can implement early intervention (Miller et al., 2010). If children
are treated in their natural environment, optimal and meaningful change can take place, peer support
is possible, and teachers can become familiar with effective intervention strategies (Miller et al., 2010).
Miller et al., (2010) reported, “[t]aming Worry Dragons (TWD; Garland & Clark, 2000) is a locally de-
veloped CBT program for anxiety disorders that uses language, pictures, and images familiar to North
American Children” (p. 434). The materials are available to schools and can be taught to entire class-
rooms with children ranging from seven to twelve years of age. Teachers can receive a one-day train-
ing session and the entire class completes the Multidimensional Anxiety Scale for Children (MASC)
(March, Parker, Sullivan, Stallings, & Conners, 1997). This tool is a self-reporting checklist that mea-
sures physiological symptoms, worry, and inattentiveness (Miller et al., 2010). This group-based treat-
ment teaches children to use: thought-stopping, distraction, physical exercise, changing self-talk, and
exposure strategies to help them cope with and overcome their anxiety (Miller et al., 2010). The Behav-
iour Assessment for Children-Parent Rating Scales (BASC-PRS) (Reynolds & Kamphaus, 1992) is also
easily administered and provides a measurement of parental assessment of their child’s behaviour (Miller
et al., 2010). Following the intervention the students complete the MASC and parents complete the
post intervention BASC. In Miller et al.’s study, data analysis and results revealed symptom reduction
and students reported that they liked the relaxation techniques and found at least one skill helpful in
the program (Miller et al., 2010). This program was facilitated at the University of British Columbia.

34
 Hayden (2016)

Children also reported that they were less scared because they had ways to calm themselves (Miller et
al., 2010). Additionally, clinicians can also give talks to teachers on anxiety and share evidence-based
approaches. The family and school setting are very important in helping children manage their anxiety
and these skills can be taught universally (Miller et al., 2010). In school intervention alleviates cost is-
sues, long wait lists, and transportation barriers.
Parents. Parents need to realize that anxiety personality traits create stress and anxiety and that the
goal should be to manage the trait that is causing the stress and not to try to change the child’s personal-
ity (Foxman, 2004). There are certain strategies that parents can teach their child to assist them in man-
aging their anxiety. Parents need to help their child recognise the difference between perfectionism and
excellence and set realistic expectations for themselves (Foxman, 2004). Furthermore, Barrett, Rapee,
Dadds and Ryan (1996) contended that children’s choices of strategies for dealing with issues was highly
influenced by their family dynamics and patterns of behaviour. By helping children use positive self-talk
and teaching them that they cannot control other people, anxiety can be lessened. Teaching children
relaxation techniques, providing them with positive feedback, and assisting them with assertiveness
skills, parents can decrease the intensity of the anxiety (Foxman, 2004). Helping children realise that
worry is not a good way to prepare for upcoming events, encouraging children to remove “I should”
from their vocabulary, and teaching them to refrain from all or nothing thinking, will assist them in
dealing with their anxiety.
Programs of intervention. Children with anxiety are more likely to have parents with a variety of
disturbance and anxiety problems (Rutter et al., 1990). In Rutter et al.’s (1990) study, parents and chil-
dren were presented with situations and asked how they would respond and although the parents were
told they could assist their child, the final solution was the child’s. The Family Enhancement of Avoidant
Responses (FEAR) was used for this gathering of evidence (Barrett, Dadds, & Rapee, 1996). Families of
anxious children were also involved in a comprehensive program where parents were trained in skills that
would help their child manage their anxiety and avoidance as well as improve family problem solving.
Kendall’s (1994) Cognitive Behaviour Therapy (CBT) program provides this training. Barrett, Dadds,
and Rapee (1996) concluded that, “Kendall’s (1994) controlled treatment study showed that 64% of
children who had received CBT intervention no longer met diagnostic criteria at posttreatment” (p.
340). CBT plus family management (FAM) was also evaluated and it was noted that younger children
(7 to 10 year olds) responded better to the CBT + FAM condition, but for older children (11 to 14 year
olds) there was no significant difference (Barrett, Dadds, & Rapee, 1996).
Epidemiological research suggests that fewer than half of children with anxiety disorders receive care
for the disorders (Egger & Burns, 2004) and more than two thirds of the children who meet criteria for
an anxiety disorder in primary settings, have never received treatment (Chavira, Stein, Bailey, & Stein,
2004). If left untreated, childhood anxiety may develop into chronic anxiety, depression, and substance
abuse (Kendall, Safford, Flannery-Schroeder, & Webb, 2004). The Coping Cat treatment program is for
youth who suffer from separation anxiety disorder, social phobia and generalized anxiety disorder and is
conducted over the course of 16 one-hour sessions. There is also the Brief Cognitive Behavioural Ther-
apy (BCBT), which is eight 60-minute sessions, two of those having a parent consultation component.
The first four sessions focus on psychoeducation and the latter four on practising skills learned through
exposure tasks. BCBT has a therapist manual, child workbook, and a parent companion guide (Kendall,
Podell, Gosch, & Behr, 2010). Beidas et al., (2013) concluded that, “ [i]f parents accommodate their
child’s anxiety by allowing them to avoid exposures, or if they are under-involved and do not facilitate
exposures, it is likely that the effects of BCBT may be limited” (p. 143). BCBT provides a structured two
parent session and parent manual and the Coping Cat Parent Companion provides a session-by-session
guide. Giving children choice is often motivational as well when introducing exposure to tasks, which
is important for transfer of control from therapist to parent (Beidas et al., 2013).
Intervention strategies such as peer tutoring and co-teaching also resulted in decreased referral to
special education programs, increased students achievement, decreased disruptive problems, and refer-
rals for behavioural problems (Villa, Thousand, & Nevin, 2013).

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 SRRJ 1(2)

Anxiety has also been identified as an associated feature of autism spectrum disorder (ASD). Chil-
dren with ASD tend to lack the social skills they need and this deficit contributes to higher levels of
anxiety (Keehn et al., 2013). An intervention program, The Multi-Component Integrated Treatment
(MCIT) (White et al., 2010) is based on components of CBT but has social skills for ASD integrated
into it (Keehn et al., 2013). It is delivered over 11 weeks and is the first known empirical study to use the
Coping Cat program including modifications, with children with ASD (Keehn et al., 2013). Although
only 36% of those who received the treatment remained free of their anxiety symptoms, scores from
pre-treatment to follow-up reveal that treatment gains were made (Keehn et al., 2013). Parents had also
perceived that their children had displayed lower levels of anxious behaviour.
It is evident that there are a multitude of programs and literature available to children, educators, and
parents for intervention and treatment of anxiety. Children who have one type of anxiety disorder often
have another mental health issue. This cooccurrence is referred to as co-morbidity. As more research is
completed, there may be better treatments made available and further gains in this area of study.

Depression in School Age Children

According to Kauffman (2013), “[d]epression has been relatively neglected in special education re-
search, even though it’s become clear that depression is closely related to a variety of other disorders,
and to academic and social difficulties” (p. 295). Childhood depression may also be accompanied by
other disorders such as: anxiety disorders, conduct disorders, attention deficit-hyperactivity disorder,
learning disabilities, school failure, and has also been found to affect some children with autism (Kauff-
man, 2013). Children may also exhibit inappropriate conduct such as: aggression, stealing, and social
withdrawal (Kauffman, 2013). Weight gain or loss may also be observed. It is important to note that
there are two main groups of causes of depression, biological and environmental, with social and envi-
ronmental being the most prevalent (Lebrun, 2007; McKnew, Cytryn, & Yahraes, 1983).

Causal Factors and Prevention

School connectedness. Shochet, Dadds, Ham and Montague (2006) conducted a sampling of
2,022 students (999 boys and 1,023 girls) ages 12 to 14 twice, at intervals of twelve months apart to de-
termine if school connectedness was a factor in adolescent depressive symptoms. School connectedness
was described as school engagement, bonding, and attachment as students begin to rely less on family
and more on extrafamilial relationships found in friends (Goodenow, 1993). School connectedness ac-
counted for 13% to 18% of the emotional distress in various age groups (Resnick et al., 1997) although
there has been little research on the relation between school connectedness and anxiety and depression
symptoms in adolescents (Shochet et al., 2006). Overall, school connectedness predicted future mental
health problems, rather than mental health problems predicting future school connectedness (Shochet
et al., 2006). Self-worth is also a risk factor for depression in youth. It is important to analyse self-worth
contingencies before depressive symptoms surface in early adolescence (Burwell & Shirk, 2006).
Rumination. Nolen-Hoeksema (1991) posited that, “rumination, a cognitive style that involves pas-
sively brooding about one’s mood, would lead to increases in depressive symptoms, while distraction
and problem-solving would lead to decreases in symptoms” (p. 545). Rumination has been identified as
a risk factor for the development of depressive symptoms in adolescents and those who engage in rumi-
nation worry excessively but passively about their depression (Hilt, McLaughlin & Nolen-Hoeksema,
2010; Nolen-Hoeksema, 1994). Ruminative responses appear to interfere with individuals’ ability to
generate solutions while accessing negative thought and memories, which enhances the depressed mood
(Nolen-Hoeksema, 1994).
Parents. Parents who become hostile and critical when their children are experiencing problems
might impact their child’s sense of inability to solve problems and decrease their enthusiasm (Nolen-
Hoeksema, Wolfson, Mumme, & Guskin, 1995). When a child reacts with frustration to a task, a parent
may also become frustrated and perhaps hostile (Nolen-Hoeksema et al., 1995). Some studies also show
that children of mothers who have depression are at risk for developing a sense of learned helpless-
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 Hayden (2016)

ness (Nolen-Hoeksema et al., 1995). Conversely, parents who were over-restrictive and controlled their
children’s opportunities for decision making had children who were more passive and withdrawn from
difficult social situations (Baumrind, 1973). Marital conflict and poverty can also negatively affect the
child and the mother (Hammen, Adrian, Gordon, Burge, Jaenicke, & Hiroto, 1987).
Gender. The Response Styles Theory (Just & Alloy, 1997) was used to explain the differences in
rumination amongst men and women. The theory suggests that women are more likely to ruminate
than men while men are more likely to use distraction or problem-solve (Nolen-Hoeksema, 1987, 1991).
Nearly one in five adolescents will experience a major depressive episode in their teen years with females
twice as likely to suffer from depression (Crisp, Gudmundsen, & Shirk, 2006). Hilt et al., (2010) con-
cluded that, “[a]lthough some research indicates that girls are more likely to report using a ruminative
response style compared to boys, gender differences in the tendency to distract and problem-solve have
rarely been examined in youth” (p. 547).

Symptoms
There are a variety of checklists that may guide teachers and parents as they work and interact with
children. Lebrun (2007) noted that some of these checklists have been adapted from those developed
by the National Institute of Mental Health to help teachers and parents identify a variety of symptoms.
These checklists focus on four general areas: major depression in children, major depression in adoles-
cents, early onset bipolar disorder (manic depression), and bipolar disorder in adolescence (Lebrun,
2007). When interpreting the data from the checklists it is important to study all aspects and identify
the situations that are presenting challenges. Collaboration with medical practitioners, parents, and
educators is necessary to identify and address dysfunctional behaviours (Lebrun, 2007).

Assessment, Treatment and Intervention

Assessment. There are numerous assessment tools in place to determine cognitive, social, environ-
mental and biological causes of depressive symptoms. There are also numerous treatment and inter-
vention programs in place to assist youth with depression. The Beck Depressive Inventory (BDI) is a
21-item, self-report scale that measures the symptoms of depression (Burns & Nolen-Hoeksema, 1991).
The Self-Help Inventory (SHI) is a 45-item inventory that asks people about their coping skills when
they are depressed (Burns & Nolen-Hoeksema, 1991). Students can also be screened on the Anxiety, De-
pression, and Self-Concept inventories of the Beck Youth Inventories (second edition) (O’Callaghan &
Cunningham, 2015). Other tools for assessing are: the Children’s Depression Inventory (CDI) (Kovacs,
1992), the Children’s Response Styles Questionnaire (CRSQ) (Abela, Brozina, & Haigh, 2002), the
rumination subscale from the CRSQ, the distraction subscale from the CRSQ, and the problem-solving
subscale from the CRSQ.
Treatment and intervention. Evidence-based research reveals that CBT is an effective therapy for
depression (Burns & Nolen-Hoeksema, 1991, 1992; O’Callaghan & Cunningham, 2015). Treatment
and intervention strategies vary depending on the age of the children. Burns and Nolen-Hoeksema
(1991), asserted that people suffering from depression who receive CBT with an active coping style tend
to recover more quickly than those who have a ruminative coping style. Completion of homework as-
signments also affected the extent of improvement (Burns & Nolen-Hoeksema, 1991; O’Callaghan &
Cunningham, 2015). Burn and Nolen-Hoeksema reported that homework assignments consisted of
“recording and refuting negative thoughts, scheduling more rewarding and productive activities, and
improving interpersonal communication, among others” (p. 308). Therapy sessions were scheduled once
or twice a week and ran for 12 weeks. Willingness to practise coping strategies impacted how much pa-
tients’ depression levels declined and homework completion also enhanced the rate of recovery (Burns &
Nolen-Hoeksema, 1991). Patients in CBT were also more likely to complete their self-help assignments
and homework if they had warm and empathic therapists (Burns & Nolen-Hoeksema, 1991). Those
who did not complete the self-help assignments and terminated therapy, reported their therapists as less
empathic and improved less (Burns & Nolen-Hoeksema, 1992).
Mindfulness meditation has also shown to reduce rumination in patients (Jain et al., 2007; Kingston,
Dooley, Bates, Lawlor, & Malone, 2007; Ramel, Goldin, Carmona, & McQuaid, 2004). Another inter-
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vention for youth depression targets children’s self-regulation of distress by identifying their responses to
distressing situations, analyzing them, and providing alternate responses (Kovacs, Sherrill, George, Pol-
lock, Tumuluru, & Ho, 2006). By reducing rumination and increasing problem solving and responses
to distressing situations, children can reduce their depressive symptoms (Kovacs et al., 2006). There is
also evidence that psychotherapy can successfully treat adolescent depression (Crisp et al., 2006).
School. The Anxiety, Depression and Self-Concept inventories of the Beck Youth Inventories (second
edition) are used to measure fearfulness, worry, anxious bodily symptoms, sadness, negative thoughts,
associated bodily symptoms, competence, and self-worth (O’Callaghan & Cunningham, 2015). The
Adolescent Mood Project (AMP) is a study that uses evidence-based CBT delivered by therapists in a
school-based setting (Crisp et al., 2006). Nearly one in five adolescents will experience a major depressive
episode in their lifetime and this depression is associated with diminished achievement and poor school
performance (Birmaher, et al., 1996). Manic Depressive Disorder (MDD) is strongly related to suicidal
behaviour, mood disorders in adulthood, substance abuse, and school drop-out (Rohde, Lewinsohn,
& Seeley, 1991). For these reasons, MDD targeted intervention should take place during adolescence
(Crisp et al., 2006). Youth who do receive mental health treatment periodically miss appointments and
often drop out early at a rate of 40-60 %, which prolongs treatment (Crisp et al., 2006). Barriers that
are associated with youth attrition are: transportation, family crises, cost, perceived effectiveness of
treatment, and scheduling difficulties (Kazdin, Holland, Crowley, & Breton, 1997). By transporting
treatment to the schools, some of these barriers might be eradicated although parental involvement
might also be limited (Crisp et al., 2006). Extant literature supports mental health treatment in schools
for many reasons: schools are in close proximity to youth and are trusted, transportation issues are
solved, school is a natural context where many professionals can gain information about an individual’s
functioning in different situations, and students are practising the skills they are learning in a realistic
context (Crisp et al., 2006). The project AMP was created to look at the specific needs of each school and
how to gather students from each school to attend their session differed according to scheduling along
with the availability of school personnel to assist in retrieving students (Crisp et al., 2006). Another dif-
ference among the schools was how accepting staff was when the appointments were scheduled during
class time, after school, during lunch, or during spare periods (Crisp et al., 2006). AMP intervention
consists of 12 weekly individual sessions broken into three modules, led by therapists who traveled to
the schools. The cognitions module focused on identification and restructuring of negative thoughts
and emerged because therapists were aware of the many stressors with which their students were deal-
ing with. The activities module included pleasant and mastery activities with student generated lists of
what they liked to do. Relaxation and relational techniques were added to this mix. The relational issues
module dealt with interpersonal issues such as anger management, problem solving, and social issues.
It also dealt with short-term goal setting. There was also a homework component and a Personal Mood
Manager (PMM) teen manual. This cognitive treatment demonstrated efficacy and taught specific skills
that focused on activities and how they affected mood. Teachers, counsellors, nurses, or administrators
could refer participants. Once this is done the participants are informed about the program and depres-
sive symptomatology is assessed using the mood modules of the Computerized Diagnostic Interview
Schedule for Children (C-DISC) (Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000) and the self-
report BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Of the participants, 78% expressed
concomitant experiences of fear, helplessness, or horror based on major life events, school hassles, family
conflict and divorce, thoughts of pregnancy and sexually transmitted disease, and skipping meals due
to a lack of money (Crisp et al., 2006). Students also expressed suicidal ideation and attempts and 50%
reported that they had never received prior mental health treatment (Crisp et al., 2006). School person-
nel and administrators felt positive about the progress that participants made and how smoothly the
integrated treatment worked in the schools. Crisp et al. (2006) noted that participants stated, “[n]ow
I have the tools that I can use when depression comes back; I have learned how to think about things
differently in a more helpful way; I wouldn’t have gotten this help if this wasn’t at school” (p. 302). Diffi-
culties with the program are that part-time coordinators are not in regular contact with the students and
staff when students are being discussed. Another obstacle is availability of space to hold sessions. Stu-
dents periodically miss sessions due to fire alarm and assemblies or other school functions. Also, several

38
 Hayden (2016)

students dropped out due to moving schools or being expelled from school (Crisp et al., 2006). Schools
do not have adequate funding in place to employ counsellors to the extent that they are needed and if a
school does have a full time counsellor much time is taken up testing and performing other duties that
are expected of them (Crisp et al., 2006). Project AMP also has external funding that can be provided
to schools to allow staff compensation when working on this program. In order to make evidence-based
therapy available to schools, funding allocations need to be examined and changed and community
mental health systems integrated with educational systems (Crisp et al., 2006). Studies need to be shared
with schools to determine what programming needs to be in place to best serve students and work along-
side parents. Project AMP shows promise when transferring evidence-based treatment to the schools.
Cool Connections (Seiler, 2008) is a group-based, early intervention strategy that uses illustrations,
games, theory and fun activities to encourage positive thinking and how to deal with worries and anxi-
eties (O’Callaghan & Cunningham, 2015). Seiler (2008) outlined that “[t]he Cool Connections Pro-
gramme is closely linked with the National Curriculum, especially in relation to PSHE (Personal, Social
and Health Education) guidelines at Key Stage 2 (7-11 years) and 3 (11-14 years)” (p. 19). Qualitative
data were gathered from children who were a part of the program asking them if they found the program
helpful or useful (Seiler, 2008). The feedback was positive. All nine participants would recommend the
program to other children and reported that it helped them understand, accept, and settle their feelings
(Seiler, 2008). The children felt that it helped them with anger and stress and gave them opportunities to
make new friends (Seiler, 2008). To boost homework completion rates in this program, personal choice
was added and a prize was given for those who completed a set number of tasks (Seiler, 2008). Limita-
tions of the study were that no follow up was done to see if progress was retained. The evidence was also
self-reported and would have been better if triangulated from other responders. It was also noted that
some of the children knew the facilitators while others did not, which might have impacted their growth
(Seiler, 2008). In summary, this pilot study provided evidence for the efficacy of group-based CBT
intervention delivered at the school level (Seiler, 2008).
Figure 1 provides the improvements in symptoms of anxiety, depression, and self-concept in the
intervention group after the 10-week, Cool Connections cognitive behavioural therapy (CBT) interven-
tion.
Based on paired samples, improvements in symptoms of anxiety, depression and self-concept were
noted. Symptoms of anxiety and depression were reduced by half and self concept increased. Lebrun
(2007) maintained that teachers need to remain flexible and learn about mood disorders. By identifying
and reducing stressors in a classroom, the atmosphere becomes safer and depressive symptoms in chil-
dren can be reduced (Lebrun, 2007). Teacher awareness around bullying, boredom, and competition
can provide succour for a child who is depressed and can prevent them from slipping into depression
(Lebrun, 2007). Teachers can also work out signals with students who need their help for a variety of
reasons. Children with depression are often late due to fatigue and punishing them for being late will
not cure the tardiness (Lebrun, 2007). Communication between home and school is vital and can be
done in many ways. Allowing children to have body breaks and something as simple as a drink of water
can help, due to the fact that water is a calming agent in addition to the child being able to leave a stress-
ful situation momentarily (Lebrun, 2007). Depressed children will often experience lower grades and
will not transition well. Flexibility with assignments and allowing extra time and giving notice when
transitioning will help to alleviate these fears (Lebrun, 2007).

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Figure 1. Northern Ireland Pilot Study of Cool Connections Intervention 2015

Figure 1: Improvements in symptoms of anxiety, depression and self-concept in the

intervention group after the 10-week, Cool Connections cognitive behavioural therapy (CBT)
intervention. Reprinted from O’Callaghan and Cunningham, 2015, p. 318.

Reilly (2015) also gave a variety of suggestions for classroom teachers. Suggestions include giving
movement breaks, using multiple methods of instruction and reminders during transitions, and in-
corporating students’ interest and strengths into assignments. In addition, teachers can segment as-
signments, identify assignments that make the child anxious, offer different ways for a child to have
notes and instructions, provide alternatives to class presentations, schedule the more demanding assign-
ments in the afternoon, and encourage input from the student. Reilly offered a multitude of lessons for:
identifying feelings, cognitive restructuring, contingency management, behaviour support, increasing
positive affect, and relaxation skills. Reilly also outlined a plan upon re-entry to the classroom from
a psychiatric hospitalization and what to do when self harm, and suicidal attempts and thoughts are
voiced. Students with depression need supportive, patient, and flexible teaching.
Merrell (2013) has written a practical guide to assist teachers in helping students to overcome depres-
sion and anxiety. He has chapters that offer: assessment and intervention planning, social and emotional
tools, cognitive therapy interventions, and other strategies for dealing with anxiety and depression.
There is a host of literature written to assist educators when dealing with students who have depression
or depressive symptoms. Knowing what signs to look for in students with mental health issues is key to
addressing their needs and offering support.
Parents. Lebrun (2007) argued that, “[i]t is crucial for parents to remember that their parenting
did not cause the child’s depression” (p. 75). A series of events may have triggered the depression,
which is known as situational depression. Chemical depression is a functional problem with the brain.
Encouraging outdoor activity but not forcing it is good as it causes the brain to release endorphins and
improve the mood of the child (Lebrun, 2007). Using positive feedback when a child has done some-
thing good is also effective. Observing sleep patterns is also beneficial to ensure that children do not
receive too little sleep or are oversleeping. Ongoing communication is important to encourage children
to talk about their feeling to family and friends (Lebrun, 2007). It is also a good idea to have children

40
 Hayden (2016)

journal their feelings. A diary can be used to document incidents and how effective interventions are.
Ongoing communication with the school to develop an instructional plan that work best for children
is paramount. Lebrun (2007) noted that, “triggers may be bright lights, noise, large stores, and groups,
which can be over-stimulating and overwhelming” (p. 77). “Once the child is home, use gentle music,
relaxation tapes, dim lights, warm baths, and massage to help with the calming, and eventually, sleep”
(Lebrun, 2007, p. 77).
Gentle and patient communication is important when a child is reaching out for support. Stability
of family meals and predictability of routines is also necessary. Validating feelings when a child is acting
out and setting appropriate age and ability expectations is key to keeping the communication lines open.
Lebrun (2007) maintained that parental monitoring is important
Keeping the computer in a public place so parents can watch for prurient people on line can save a
child’s life (Lebrun, 2007). If the family needs counselling, it is a good idea for the parents to go first so
they can receive counselling and education on the issues that the family is facing. Spend time not money
with your children and ignore critical comments by friends, relatives, and strangers (Lebrun, 2007). It is
crucial to maintain a sense of hope and to take care of oneself. Society has a tendency to blame parents
for how their children are. Lebrun (2007) concluded that, “[h]opefully with more awareness, mental-
health issues will be received with more of an open mind, and thus, more tolerance” (p. 81).

How the Study Addressed the Research Questions

The purpose of this study was to examine the prevalent mental health disorders and determine what
the causal or correlational factors were. Researchers have concluded that anxiety is often comorbid with
depressive symptoms. Girls between the ages of 12 and 15 were more likely to suffer from depression
than boys due to their tendency to be more helpless in their ruminative reactions to situations (Nolen-
Hoeksema, 1994). Causal or contributing factors ranged from hereditary to environmental and had
varying levels of impact on children. Parental over-restrictiveness and intrusiveness puts children at risk
for anxiety disorders (Aschenbrand & Kendall, 2012; Vaughn, Feinn, Bernard, Brereton, & Kaufman,
2013; Kearny, et al., 2014). Children who had parents suffering from anxiety were also at greater risk.
Peer and teacher relations also impacted students with anxiety. Feelings of lack of inclusion and not be-
ing able to meet teacher expectations worried students (Loke & Lowe, 2014). School connectedness was
a factor in children with depressive symptoms (Shochet et al., 2006). Ruminative behaviour was also a
causal factor. Children who have parents who are hostile, critical or suffer from depression are also at
risk for developing depression (Nolen-Hoeksema et al., 1995).
Studies concluded that prevention needs to be implemented early in order for it not to carry on into
adulthood (Dadds & Roth, 2008). Preventive measures and early intervention can reduce the risk of
an onset of a disorder and if schools adopt this type of approach, they can identify, treat and possibly
prevent the onset of a disorder (Tomb & Hunter, 2004). There are a number of preventive programs that
are currently being used in schools.
There are a host of tools that can be used to assess and diagnose children. CBT intervention strate-
gies range from programs that are run by clinicians and counsellors to school wide and classroom-based
instruction. FEAR and Coping Cat are two intervention programs that are successful in the schools.
Programming that has a parent component also yields greater results in minimising depressive and
anxious symptoms and gives parents strategies to support their children in skill acquisition. CBT and
BCBT interventions usually take place with a therapist across a range of clinical settings (Keehn et al.,
2013). There are also homework components to many programs and if students complete this part of
the therapy, they tend to have better results with recovery (Burns & Nolen-Hoeksema, 1991). Par-
ents who are receptive to family-based treatment can also play a role in the recovery of their child and
perhaps themselves. In order to continue to assist these students, further research needs to be done
into developing school-based mental health programming to minimize cost, missed appointments, and
transportation barriers.

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Implications

Implications for Research

This study confirms the recommendation of Barett (1996) that further research is needed to examine
the optimum intervention length. It also confirms that parental involvement in treatment improves
outcomes in the CBT of children. Beidas et al. (2013) also recommended that further research is needed
to explore why some individuals did not respond to treatment; researchers need to study baseline charac-
teristics of youth in order to decide which treatment works best for whom. Additional studies are needed
to determine why willing patients improve more and if these effects are limited to CBT (Burns & Nolen-
Hoeksema, 1991). There are several methods for screening for anxious symptomatology although few
studies have been done to investigate the best method for screening and selection of children for anxiety
treatment programs (McLoone et al., 2006). Literature in the area of treatment is limited and further
research needs to be done to make more informed conclusions. Despite the significant amount of un-
treated depressive disorders in schools, school systems do not regularly screen or identify students (Crisp
et al., 2006). Future research is also needed to clarify the relationship of gender differences in response
style (Hilt et al., 2010). Developing programs that reduce rumination and enhance problem-solving
skills as well as examining cultural differences in response styles, are also vital goals for future research
(Hilt et al., 2010). It is clear that the literature repeatedly recommends that more research needs to be
done in the area of addressing the needs of children with mental health issues in schools.

Implications for Practice

This literature review confirms the recommendation of Miller et al., (2010) that evidence-supported,
school based treatment overcomes many of the barriers associated with treatment. With school based
treatment, cost, long waiting periods, and the risk of developing additional mental health issues are al-
leviated (Miller et al., 2010). Early emphasis on exposure tasks is the most important ingredient in CBT
when treating anxiety (Beidas et al. 2013). If left untreated these issues can carry on into adulthood and
worsen. It is also recommended that parents also receive treatment in the accompanying parent sessions
to ensure the success of the CBT and BCBT. O’Callaghan and Cunningham (2015) maintained that
studies found that both CBT and non-CBT based interventions were successful in reducing symptoms
of anxiety and depression. Group-based programming, such as Circle Time, can also be implemented
in the schools without the need for a specific program (O’Callaghan & Cunningham, 2015). Crisp
et al., (2006) concluded that evidence-based treatment, such as AMP is a feasible area of research for
further investigation into who will benefit from which treatment. It is equally important that students
cope actively with their problems in order to experience greater clinical improvement (Burns & Nolen-
Hoeksema, 1991). The literature confirms that more programs are being developed to meet the needs
of students and their families at the school level on an individual, small group, and class wide basis.

Conclusions

It is apparent that CBT and Social Emotional Learning (SEL) are needed in schools on a day-to-day
basis to meet the needs of students with mental health issues. These programs assist with the develop-
ment of self-concept, school adjustment, motivation, and engagement as well as relational development
(Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Teaching these intervention strategies
benefits all students as they interact with each other; explicit instruction in this regard would assist all
learners. Research suggests that school based mental health programs best serve all students and has re-
duced the need for suspensions (Bruns Moore, Stephan, Pruitt, & Weist, 2005). Collaboration between
school mental health, social services, school staff, and the community is also important to the success of
the programming (Brener, Weist, Adelman, Taylor, & Vernon-Smiley, 2007). The role that parents play
in treatment and recovery is very important, too. Equally important is supportive leadership to main-
tain and sustain this programming. Having a full time staff member in one building to deliver this in-
tervention is optimal. Due to financial constraints and budgeting, this support often is not a possibility.

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 Hayden (2016)

There are a variety of causal factors that impact students with anxiety and depression ranging from
environmental to biological and a plethora of intervention strategies to assist these children in recovery
as well as numerous on line resources to assist personnel working with children. There is a preponder-
ance of evidence that supports CBT as a treatment (Crisp et al., 2006). Prevention programming also
increases successful treatment of students. As more research is conducted, programs are being refined
and altered to meet the needs of individuals, small groups of students, and classrooms. With policies
and initiatives shifting and changing, mental health issues and school-based programming need to be
maintained and given priority. The future success of these students depends on the collaborative efforts
of all stakeholders and their commitment to future development and implementation of school-based
mental health programming.

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